1. California Radiological Society 1 Capitol Mall, Ste. 320 Sacramento, Ca. 95814 (916) 446-2028 www.calrad.org

2. Medi-Cal Duals Transition  Part of demo project in multiple states  Move Medi/Medis into managed care plans  About 1.1 M patients in Ca. SPDs in 2012  Why- they are highest cost, multiple chronic conditions, 2/3rds are 65 plus

3. Medi-Cal Duals, Cont…  Coordinated Care Initiative- integrated model of care- reduce fragmentation  Initially proposed for 8 counties  Initial start March 1, 2013 implementation  CMS approval-delay again to March 2014

4. Ca MediConnect  LA County phase in over 18 months  San Mateo enroll all eligible  Orange, San Diego, San Bernardino, Riverside, Alameda, and Santa Clara over a 12 month period

5. Ca MediConnect  Going slowly  Problems w/ Alameda Alliance/ Solvency  CalOptima- audit quality issues  LA Care- not ready  LACMA files suit to challenge transition

6. 10% Medi-Cal Cut 2011  Legislature approved 10% cut for most providers  June 1, 2011 effective date  DHCS provided data in September-would monitor access prospectively  Fed. Dist Ct grants injunction in Jan 2012

7. 10 % Provider Rate, Cont…  December 2012 Court of Appeal Reversed injunction  Bills in 2013 to eliminate reduction/claw back- Gov. says no  DHCS schedules 10% prospective rate cut for docs 1/9/14

8. 10 % Cut  Gov.s 2014-15 budget proposal eliminates clawback for docs- $400M  AB 1805 ( Skinner and Pan) eliminates 10% retro and prospective cut  Budget #s eliminate retroactivity for Docs and some others

9. 10 % Cut  Impacted cap rates to Medi-Cal managed care plans- starting 10/1/13  Exempts specialty physician services  Appears that PC for radiology, rad onc and nuc med will not be included

10. Bill to Close IOASE Exemption  SB 1215 ( Hernandez) amended in March  Part of cost containment strategy  Would include high end diagnostic and radiation oncology  GAO studies document increased utilization

11. IOASE Exemption Bill  What changed  Coalition of supporters  Included plans, Health Access, some unions  What Did Not Change  Strong opposition  Claim that GAO did not recommend elimination  Issue w/ PT

12. MICRA: The History

13. MICRA Provides  UNLIMITED economic damages for any and all past and future medical costs.  UNLIMITED economic damages for lost wages and lifetime earning potential.  UNLIMITED punitive damages for malicious or willful conduct.  ADDITIONALLY, up to $250,000 for non-economic damages.  LIMITS the amount of money a lawyer can take as payment for representing an injured patient.

14. California vs. U.S. Premiums 1976-2012 Source: NAIC Profitability By Line By State 1976-2012 (Medical Malpractice) Prepared by: NORCAL Mutual 2/6/14 *Includes California U.S. Premium + 746%* + 746%* CA Premium + 241% No Crisis in California $ Billions

15. States Without Medical Liability Reform Suffer Source: Medical Liability Monitor, 2013 professional liability rates

16. Proposition 46 Components  100% of funding has come from trial lawyers and their allies.  Prop. 46 includes three main components:  Drug and alcohol testing for physicians:  Random testing, administered by hospitals  Testing after an “adverse event” at a hospital  Mandatory use of the CURES prescription drug database.  Changes MICRA’s non-economic damages cap to $1.1 million with annual increases going forward.  The first two are “bait & switch” or “sweetener” provisions designed to appeal to voters and mask the real intent: to change MICRA.

17. MICRA Change $1.1 million  Quadruples MICRA’s non-economic damages cap from $250,000 to $1.1 million on January 1, 2015, and increases annually for inflation.  Trial lawyers will triple their legal fees  Higher liability rates translates into to consumers paying higher health care premiums.  Doctors may leave California or stop practicing entirely.  According to a study by California’s former Legislative Analyst, Prop. 46 will increase health care costs by $9.9 billion annually. This means it will cost a family of four more than $1,000 a year.

18. No on Prop. 46 Coalition

19. Get Involved  The No on 46 campaign is prepared to do what it takes to defeat this costly and dangerous initiative, but we need your help.  Please join the coalition, sign up for updates, and request free campaign materials at www.NoOn46.com. Photo courtesy of La Clinica de la Raza

20. Bill on Provider Contracting  AB 2400 ( Ridley-Thomas)- All Products Clauses- CMA sponsored  Prohibit plan from including in provider contracts that must except/participate in all networks or products that pan offers or may offer  Must allow physician to agree and opt in for each product or network